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Fitzpatrick, S. J. (2016). Ethical and political implications of the turn to stories in suicide prevention. Philosophy, Psychiatry & Psychology, 23, (3/4), 265-276. Available from: doi:10.1353/ppp.2016.0029

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Ethical and Political Implications of the Turn to Stories in Suicide Prevention

Scott J. Fitzpatrick

Centre for Rural and Remote Mental Health, The University of Newcastle

PO Box 8043, Orange East, NSW 2800, Australia

scott.fitzpatrick@newcastle.edu.au

Abstract The stories of suicide attempt survivors are gaining broader currency in suicide

prevention where they have the potential to provide privileged insights into experiences of

suicide, strengthen prevention and intervention measures, and reduce discrimination and

stigmatization. Stories of suicide, however, have a double-edged power insofar as their

benefits are counterweighted by a number of acknowledged harms. Drawing on the literatures

and methods of narrative, and in particular, narrative approaches to bioethics, I contend that

suicide prevention organizations make possible yet constrain the creation of personal stories

of suicide, shaping the discursive meanings of public stories of suicide while setting limits on

which stories are valued, legitimized, and rendered intelligible. Personal stories of suicide

serve as important sites of meaning-making, power, and social identity, yet they also

reproduce and normalize particular ways of thinking, acting, and communicating that

reinforce the institutional logics of suicidology. These have ethical and political force as they

help to frame the ways suicide is understood, the ways it is subjectively experienced, and the

ways it is responded to.

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Keywords Suicide, suicide attempt survivors, suicide prevention, narrative, bioethics,

suicidology

One of the distinguishing features of the ‘narrative turn’ in bioethics has been the question of

authorship. For bioethicists and clinicians worried about the distorting and diminishing

effects of an increasingly objective, dualistic, and value-free medicine, narrative has played a

leading role in establishing the importance of patients’ stories to the therapeutic endeavor

while calling attention to the inadequacies of biomedicine (Arras, 1997; Brody, 1997).

Narrative is seen as a way of ceding patients the moral authority to tell their stories, while at

the same time recognizing the value of patients’ stories to clinical practice. Because illness is

an embodied and, therefore, deeply personal experience, stories enable persons to make sense

of their lives in the midst of illness and suffering and help to make healing possible (Frank,

1995; Kleinman, 1988).

More recently, the field of suicidology—often defined as the scientific study of

suicide and suicide prevention—has witnessed a similar shift in recognizing the importance

of personal stories of suicide to its practice. Dominated for the most part by epidemiology,

clinical psychiatry, and psychology, suicidology has been criticized by those bereaved by

suicide for its objectivity, inaccessibility, use of inappropriate terminology, and for sanitizing

the “‘raw’ reality of suicide” (Cutcliffe & Ball, 2009, p. 211). This places it in conflict with

the anecdotal and subjective accounts of persons bereaved by suicide and poses a significant

barrier to collaboration and care (Cutcliffe & Ball, 2009; Myers & Fine, 2007). Those who

have struggled with ongoing suicidality or who have been hospitalized after a suicide attempt

have also reported a degree of divergence between their experiences and the language of

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experts that describe them (Webb, 2006). The dispassionate, detached, and objective reports

of researchers, they argue, are ill-suited for capturing the chaos, ambiguity, and confusion of

the suicidal crisis and the myriad challenges faced by persons after a suicide attempt. In

response to these criticisms, organizations engaged in suicide research and prevention have

argued for greater involvement of previously suicidal persons and those bereaved by suicide

in suicide prevention initiatives, and for increased research and funding into the ‘lived

experience’ of suicide (American Association of Suicidology, 2014; Suicide Prevention

Australia, 2009). To this end, both the American Association of Suicidology and Suicide

Prevention Australia have established formal suicide survivor/lived experience networks. For

these organizations, the knowledge to be gained from those with lived experience is critical to

modifying attitudes and to altering policies, programs, and practices, thus imparting personal

narratives of suicide with a particular transformative power.

The epistemological value of narrative, therefore, is closely linked to its capacity to

effect profound personal, social, and/or institutional change. One way that narrative

contributes to what broadly might be referred to as the ethics of suicide, then, is as a form of

moral education. The role of narrative in moral education has been the focus of works by

Martha Nussbaum (1990) and Anthony Cunningham (2001), among others. These scholars

acknowledge the importance of language, emotion, and reflection to the development of

moral capacities. In the social realm, where the meaning of suicide and the experiences and

interactions between suicidal persons, health professionals, community organizations, family

members, and friends are morally significant, narrative directs and heightens our attention to

morally salient features of human experience. Such issues are of primary concern to those

engaged in the treatment and care of suicidal persons, and the work of Cutcliffe and others

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(2002, 2007) is especially valuable for its attention to the stories of suicidal persons and a

recognition of their importance for the provision of humane and effective care.

Although the virtues of narrative have been extolled as a way of morally enriching our

understandings of suicide, there is an implicit danger in viewing stories, as is often the case,

as essentially ‘soft’ or ‘benign’ and interested in enhancing our understanding of suicide only.

Narratives are also exclusionary; they privilege and value certain kinds of reasoning and

knowledge over others. They provide ways of seeing and representing suicide that have

practical and ethical implications and, therefore, should not escape critical scrutiny. The

transformative and healing power of narrative is well-documented in the illness narrative

literature, however, the ethical value of stories of suicide—in particular, their role as a tool of

moral edification—is less well-understood. Indeed, a strong body of research has

demonstrated a correlation between fictional and nonfictional media representations of

suicide and actual suicide, suggesting that stories of suicide may be morally harmful (Gould,

Jamieson, & Romer, 2003; Hawton & Williams, 2001).

Concern about the potential danger of public stories of suicide has led to the

development and implementation of best practice guidelines regarding the responsible

reporting of suicide. These guidelines focus on such things as the need to take caution when

reporting on the methods of suicide and of avoiding insensitive, gratuitous, or sensationalistic

language, but they also emphasize particular story components. For example, stories that

adopt a more permissive attitude toward suicide, that romanticize or politicize suicide, or that

are critical of conventional treatments and interventions are discouraged in favor of those that

more fully explore the risk factors for suicide, or those that stress its impacts on family,

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friends, and the community, thus emphasizing the tragedy of suicide and encouraging people

to seek help (Hunter Institute of Mental Health, 2014).

These divergent views on the role and value of stories of suicide in the public sphere

suggest that stories of suicide have a double-edged power to both heal and harm. They also

indicate that the formation and dissemination of stories of suicide in contemporary culture are

deeply embedded within institutional structures that influence its content, style, modes of

discourse, and, importantly, its erasures and silences (Saris, 1995). Storying suicide in

contemporary suicidology, therefore, is not simply a matter of letting people tell their stories,

but is “a form of social and political prioritizing; a particular way of telling stories that in its

way privileges some story lines and silences others” (Goodson, 1995, p. 94).

Narrative theories and methods provide useful tools for thinking about personal

stories of suicide and, in particular, about the narrative forms admissible within the bounds of

suicidology and the political and moral interests they serve. In what follows, I present an

overview of the context in which the call to stories in contemporary suicide prevention is

grounded. Drawing on the literatures and methods of narrative, and in particular, narrative

approaches to bioethics, I argue that although personal stories of suicide confer certain

privileges and benefits on survivors of suicide attempts, they also manifest and normalize

particular ways of thinking, acting, and communicating that have considerable ethical and

political force in shaping the ways suicidal behavior is understood, the ways it is subjectively

experienced, and the ways it is responded to. Finally, I discuss the implications of this for

suicidal or recently suicidal persons, suicide research, and for public discourse.

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A Bioethical Approach to Contemporary Stories of Suicide

Suicide, writes Margaret Higonnet “provokes narrative, both a narrative inscribed by the

actor as subject, and those stories devised around the suicide as enigmatic object of

interpretation” (2000, p. 230). For Higonnet, the proliferation of narrative is a necessary

consequence of suicide as persons are compelled to interpret its meaning, and narrative, one

of the primary ways this is done. Family members who have lost a relative to suicide

invariably try to make sense of it through narrative (Owens, Lambert, Lloyd, & Donovan,

2008), as do coroners and researchers who use interviews and other biographical material to

report their findings (Langer, Scourfield, & Fincham, 2008). Clinicians use narrative

extensively in their work with patients and through the construction of case notes and studies

(Hunter, 1991). Suicidal or recently suicidal persons also articulate their thoughts and

feelings in everyday conversational narratives—with family, friends, or with counseling or

other medical professionals—but also through diaries, online discussion forums, and suicide

notes. However, not everyone has been accorded the same epistemic or moral authority when

it comes to explaining suicide. Persons who have engaged in suicidal acts have been largely

disqualified as sources of critical and potentially transformative knowledge. First, on

epistemic grounds, which dismiss subjective self-reports because they do not accord with the

standards of scientific method; and second, on moral grounds, with broad concerns expressed

about the potential danger of public stories of suicide.

Recent and ongoing criticism of suicidology, particularly with regard to its epistemic

conservatism (Hjelmeland & Knizek, 2011; White, 2012), the disjunction between scientific

and experiential accounts (Cutcliffe & Ball, 2009; Webb, 2006), and limited advances in

suicide prevention are, for an increasing number of scholars, symptoms of a broader crisis of

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the biomedical paradigm of contemporary suicidology. Although suicidology retains a strong

biomedical focus, it also encompasses a range of new institutional frameworks, strategies,

and practices that include health promotion and education, peer involvement, intersectoral

collaboration, and community and workplace-based initiatives.

These tensions and advancements are useful for understanding the emergence and

endorsement of personal stories in contemporary suicidology, as is the widening influence of

narrative in the human and social sciences. As Hyvärinen (2006) has argued, the emergent

interest in narrative was not simply an extension of previous linguistic concerns in

philosophy and critical theory; it also highlighted growing disillusionment with the abstract,

objectivist approaches of existing human and social scientific research. The expansion of

narrative research within the field of bioethics coincided with this upsurge in philosophical

and methodological interest in the role and value of narrative, and with a more flexible and

pragmatic notion of ethics.

Philosophers in the dominant Anglo-American (or analytic) tradition of moral

philosophy have characteristically viewed the project of ‘doing ethics’ with the somewhat

ambitious task of formulating moral rules about the rightness of human actions (Walker,

1998). In this view, ethics is primarily a task of thinking and judging clearly according to

relevant norms, theories, and principles. In recent decades, this view has come under

increasing criticism for its (mis)representation of morality as a compact, impersonal, and

codifiable set of law-like propositions for guiding human conduct. For philosophers such as

Margaret Urban Walker (1998) and Martha Nussbaum (1990), such approaches foster an

abstract, intellectualist, and impersonal picture of morality and moral knowledge that is not

an accurate reflection of human moral life. Narrative approaches, through their attention to

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the rich and subtle nuances of human lives and action, are thus seen as a corrective to the

impersonal, law-like approaches that have dominated moral theory (Arras, 1997).

As well as its normative dimension in acting as a guide to human conduct and action,

Walker (1998) sees moral philosophy as the bearer of a descriptive and empirical

responsibility toward the study of moral understandings and moral experience across a

multitude of social orders and practices and involving a multitude of moral subjects. ‘Doing

bioethics’ from a narrative perspective, therefore, means reflecting on the moral aspects of

particular stories told within powerful social institutions (Nelson, 1997, p. xii). For what is

needed in some cases is less a set of principles for resolving issues, but a form of dialogue

that recognizes the different values, interests, and needs of those involved.

Like other illness narratives, personal stories of suicide offer a number of ethical,

political, and therapeutic benefits. First, they allow suicidal or previously suicidal persons to

be heard, garnering them both greater recognition and legitimation and helping to reduce

discrimination and stigmatization. Not only do stories offer a more personalized

interpretation of suicidal events that reflect the diversity of voices and perspectives that

constitute experiences of suicide, they also privilege the situated, ‘lived experience’ of

previously suicidal persons, recognizing them as important sources of ‘expert’ knowledge.

Second, stories may offer suicidal or previously suicidal persons a point of reflection

for grappling with problematic life events in their bid to give shape and meaning to them.

Stories provide interpretive frameworks for persons to explore and work through actual and

unresolved life events and to communicate their experiences to others. Recent empirical

research on recovery shows that meaning is crucial to the healing process and that it is closely

tied to the need for persons to tell their own stories (Bracken & Thomas, 2005). Stories may,

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in this way, be used to sort through the noise of everyday life and to gain an insight into

events and experiences (Ochs & Capps, 2001). A third important function of personal stories

of suicide is that they may provide guidance and hope to others who are experiencing similar

difficulties. The stories of those with lived experience provide alternative viewpoints to those

of experts and may be more responsive to survivors’ needs (Bracken & Thomas, 2005).

Although these functions suggest a productive view of moral agency, recognition, and

empowerment, stories may also manifest and normalize certain ways of thinking, acting, and

communicating that are in keeping with the management and regulation of socially

troublesome emotions and conduct in liberal democratic societies (Rose, 2007). Those

advocating the greater use of personal stories in suicidology argue that it is only by

empowering previously ‘silenced’ voices that the political and professional power imbalances

of scientific suicidology will be redressed (Webb, 2006). In this view, the blindness of

suicidology to personal, social, cultural, and political factors is a result of the prevailing

biomedical focus of contemporary suicidology. The counterposing of subjective experience

to an objective, impersonal, and value-free medicine is thus one of the primary justifications

for the inclusion of personal stories in suicidology.1 What this position overlooks, however, is

how stories that empower those at the margins may also coincide with and serve the interests

of clinical and public health professionals and other forms of institutional authority

(Atkinson, 2009; Costa et al., 2012).

It is often presumed, for example, that narrative provides an especially authentic form

of insight into human lives and experience. Narrative has been celebrated as a means by

which persons are able to disclose their most personal and private thoughts and feelings and,

in so doing, reveal their deepest, truest selves. Because of the marginalization of personal

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stories of suicide in the past, the telling of these stories is viewed as an ethical good in itself,

granting the storyteller recognition and empowering them to act upon their life. The story and

its telling serve as both a form of identity politics as well an act of self-creation (Atkinson,

2009; Atkinson & Silverman, 1997). For Atkinson and Silverman (1997), however, this

implicit appeal to the authenticity of narrative uncritically accepts the romantic view of

isolated individuals and overlooks the broader social structures and relationships that

contribute to biographical work. Stories might be thought of as private—revealing the

feelings, experiences, and thoughts of speaking subjects—but they are never a fully accurate

representation of them. This is not to suggest that these things do not exist or that we simply

bring them into being by communicating them; rather, that narrative does more than represent

something—it also helps to frame and interpret it (Webb, 2009). Hence, there is no way of

separating personal stories from the beliefs, values, and expectations of the cultural narrative

canon that give rise to them (Freeman, 2001).

The Recovery Narrative as Therapeutic Endeavor

In turning to actual stories of suicide in contemporary suicidology, a brief survey of

published and online sources indicates the narrative most common to this domain is the

recovery narrative. Told by persons who have made a previous suicide attempt, this story

adheres to the following basic structure: Person experiences profound suffering, illness,

trauma, or psychological pain; person attempts suicide; person survives; and person recovers

through a gradual process of self-awareness, self-control, and personal and professional

support. Invariably, recovery narratives not only recount a series of potentially tragic events

that befall the story’s main character before tracking toward a typically happy ending, they

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also focus on the personal, often spiritual, growth of persons as they gradually reorient and

reclaim a sense of self after the devastating effects of illness or trauma (Shapiro, 2011;

Woods, 2011).

Such stories have been the staple of illness narratives—particularly cancer

survivorship—where the capacity to tell one’s story is connected intimately to the project of

restoring one’s sense of personal identity (Woods, 2011). If the illness experience is, to some

degree at least, an epiphanic experience (Frank, 1993), then a suicide attempt may represent a

distinct turning point in a person’s life. The point where a life is no longer considered worth

living, together with the physical, emotional, and social ramifications that often follow a

suicide attempt, provide conditions that are well suited to the forging of a new identity.

Published works by Tina Zahn (2006) and Susan Blauner (2003), as well as a growing body

of stories being told on social media, give some indication of the potentially transformative

effects that a suicide attempt can have on lives.2

Survivors of suicide attempts, like users and survivors of psychiatry, have typically

rejected a narrow framing of suicide as the outcome of mental illness, instead situating their

illness within a broader personal life history. In Why I Jumped (2006), Tina Zahn recounts the

story of her life leading up to her suicide attempt, detailing her history of sexual abuse, family

problems, the experience of two terminated pregnancies, and, finally, her postpartum

depression. Although Zahn is hospitalized and receives psychiatric treatment for her

depression, she describes the partial curative effects provided by these treatments as she

comes to the realization that recovery involves more than just clinical recovery, but is closely

connected to the need to come to terms with her past.

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I knew I wasn’t cured. I had a long road of recovery ahead of me. We had the PPD

[postpartum depression] under control, but I had years of abuse, denial, and repressed

anger to wade through. All my life I’d tried to hide the pain. As a child I hid how

much it hurt to be abused and rejected. As a teen I hid how much it hurt to be

repeatedly betrayed. As a young woman, I hid the pain of two abortions. As a woman

I hid the pain of back and arm injuries. I took medications to mask the pain and to

keep on going, and I wore a mask to keep people from knowing the truth. But no

matter how hard you try to outrun the past and the pain, it catches up with you. The

harder you try to ignore it, the harder it will take you down. Now I had to learn to face

the past, forgive people, accept who I was, and to learn to love myself. It wasn’t going

to be easy. (2006, pp. 164-165)

Like other writers of illness narratives, the self that emerges after her suicide attempt is not a

radically new one (Frank, 1993). Instead, Zahn’s recovery is piecemeal and defined by

ongoing emotional and spiritual struggle. It involves her not only addressing the underlying

causes of her pain, frustration, and disappointment through an ongoing process of self-

examination and self-discovery, but of exercising honesty with herself and with others in

order to locate the ‘real’ truth about herself so as to initiate personal growth (Rimke, 2000).

Zahn writes in the close of her book:

What I wanted more than anything in my life was to be accepted for who I was and

loved unconditionally. But before I could believe that anyone loved me, I had to learn

that I was worthy of love. I tried behaving in ways that I thought people wanted me to

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behave. I tried to be compliant, submissive, obedient, and ‘good’. I didn’t speak up or

speak out. I held onto secrets until they choked the life out of me. But all the while, I

hated hiding behind a mask, knowing that I wasn’t letting anyone see the real me for

fear of more rejection. The mask is off now. The secrets are out. (2006, p. 212)

As Zahn’s account suggests, reorienting and reclaiming a new sense of self after a suicide

attempt requires not only examining one’s self privately, it also requires persons to tell their

stories in order to publicly claim this new identity, making it both a social and rhetorical

production (Bracken & Thomas, 2005; Frank, 1993).

Susan Blauner’s somewhat provocatively titled How I stayed alive when my brain was

trying to kill me (2003) is a further example of a suicide attempt survivor narrative that

situates suicidality within the context of an individual life history. Despite attempts to reduce

the causes of suicide to the brain, Blauner’s story moves freely, if somewhat changeably,

between different contributing factors—sexual abuse, loss, mental illness, relationship

problems—revealing the complex set of compounding vulnerabilities that invariably

contribute to suicidal events. Blauner’s recovery, like Zahn’s, is gradual, filled with struggle,

and draws on a number of different psychological, emotional, neurological, and spiritual

conceptualizations of suicide to explain her experiences and to aid in her recovery. And, like

Zahn’s account, it too involves an ongoing process of self-examination as a means of

effecting personal change. Blauner writes:

I had to go through what I went through in order to get where I am today, but I’m not

sure my rutty road had to be quite so long. There were plenty of opportunities to

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change my path, but I held on to self-destruction for as long as I could. When I finally

began to let go, I started to find relief, though none of it was a straight line toward

freedom. (2003, p. 25)

For Blauner, self-change requires not only honesty but self-discipline. Rather than

languishing in the depths of her depression and self-destructiveness, she is forced to “take

responsibility for her actions” to overcome her problems and achieve the sense of well-being

and connectedness she so craves (2003, p. 21). To this end, she details in the final sections of

her book the multitudinous therapeutic practices by which she comes to manage and control

her emotions and combat her suicidal thoughts.

For Zahn and Blauner, recovery, although not a purely individual process insofar as it

requires supportive environments to help realize it, is nevertheless person driven. It is

holistic, but reliant on individual, familial, and community strengths and responsibility for its

impetus. It is not a linear process and its stages are not clearly defined, yet active

engagement, self-knowledge, and rational decision-making are all considered key to the

achievement and preservation of mental well-being (National Action Alliance for Suicide

Prevention, 2014; Teghtsoonian, 2009).

Narrative, Institutional Discourse, and the Rhetoric of Self-Change

The expansion of the personal confessional genre as a technique of self-formation and its

valorization in contemporary Western culture reveals both the extent of our belief in

psychology as the root cause of, and solution to, all human conflict, as well the public

fascination with the personal and private self. It can be seen in the practice of psychotherapy,

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which sees the elicitation of the patient’s story as central to the therapeutic task, and it is also

evident in the popular media with tell-all biographies, self-help books, and celebrity

interviews acting as the medium and guarantor of truth (Atkinson and Silverman, 1997). In

these contexts, the process of telling the truth about one’s self is seen as integral to the

process of self-actualization and the necessary first step in working through one’s problems

(Rimke, 2000).

Although the act of telling one’s story seems to be an expression of personal truth,

narratives are not entirely individual and personal but are shaped by sociolinguistic

conventions embedded in established power relations that help determine their production,

circulation, and interpretation (Shapiro, 2011). “Discourses exert a structuring influence on

narrative accounts, at the same time as those accounts provide the broader parameters within

which discursive meanings are negotiated and realized” (Day Sclater, 2000, p. 131). So

although narratives may be constrained by discursive frameworks, they also offer the

possibility for persons to negotiate, resist, and transform them.

This interrelation between narrative and discourse is conceptually important because

it provides a means for examining the ways that individuals strategically deploy stories to

serve certain functions, and in so doing, position themselves in relation to prevailing social

norms (Day Sclater, 2000). Personal stories of suicide serve as a way for persons to resist the

excesses of medicalization and the stripping away of personal experience from its human

contexts. Although the view of suicide presented by survivors such as Zahn and Blauner

emphasizes the psychological and social bases for suicide over a purely biomedical framing,

their stories do not necessarily challenge the view that suicide is primarily individual in

regards to its causes, treatment, and prevention. The view of personal stories of suicide as the

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locus of self-knowledge, and the strengthening and deepening of psychological knowledge

that makes it possible to understand and act upon oneself in terms of this knowledge, means

that personal stories of suicide often reinforce the Western notion of the individualized,

psychologized subject (Rose, 2007; Watson, 1993). We must consider, therefore, to what

extent the medicalization of suicide persists within these stories, albeit within a sphere where

medical power operates within a set of local and diffuse social practices (Turner, 1997).

The self-change rhetoric found within the suicide attempt survivor literature, I argue,

both presupposes and enacts certain forms of self-relation that can be considered problematic.

By structuring human action, experience, emotion, and identity as individual and internal

rather than social and relational, suicide is presented as a primarily individual problem—one

that given the right amount of personal insight, guidance, and determination can be

overcome. It is not only biomedical approaches to suicide that lend themselves to these ways

of acting and being. The conceptualization of suicide and survivorship offered by Zahn,

Blauner, and others is the product of myriad overlapping and complementary discourses—

psychology, religion, spiritualism, and ethics—that prescribe certain ways of acting and being

over others (Rimke, 2000; Rowe, Tilbury, Rapley, & O’Ferrall, 2003). Rather than competing

with, or for that matter refuting each other, these discourses can be seen as part of a larger

project of regulating suicidal behavior and suicidal persons through practices of self-

formation.

The congruence between suicide attempt survivor narratives and public and mental

health policies and services that place greater accountability and responsibility on individuals

to manage their own health and well-being raises pertinent questions about the reliability and

authenticity of the stories of suicide attempt survivors. Although these stories provide an

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important source of knowledge about suicide and recovery after a suicide attempt—rejecting

a purely scientific understanding of suicide by drawing attention to aspects of human

experience and suicide occluded by biomedical and epidemiological research—they do so,

ostensibly, within the borders set by contemporary suicidology rather than outside them.

Suicide continues to be represented as irrational, involuntary, and pathological, and,

therefore, as requiring prevention and treatment. Although a discursive space for the

discussion of the social determinants of suicide is created, an emphasis on personal stories as

a mirror of individual experience divests these stories of systematic cultural and political

analysis (Goodson, 1995). Suicidal persons seem to speak alone, by, about, and for

themselves, rather than being seen as enacting their stories through socially shared forms or

genres (Atkinson, 2009). In viewing personal stories of suicide as a vehicle for self-

examination and self-development, the psychologized individual is celebrated and the

therapeutic interests of suicide prevention maintained.

The framing of suicide within a primarily individualistic and psychological register

has a number of ethical and political implications. First, it overlooks or downplays the

socioeconomic and political forces that shape the social determinants of suicide and the

political rationale that frames how these factors are understood as contributors of suicidal

distress (Mills, 2014). Within the prevailing individualistic model of suicide, social inequities

such as poverty, unemployment, and social disadvantage or discrimination are seen largely as

indirect causes (or ‘triggers’) for predisposing biological or psychological factors, thereby

reinforcing the view that suicide is best prevented or treated by improving mood and

changing behavior rather than through social, political, and economic reform (Mills, 2014).

The rendering of suicide in largely individualistic terms contrasts sharply with, for example, a

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critical reading of suicide that might explain it reasonably in terms of social injustice, gender

and sexual oppression, or inequitable socioeconomic environments. Such discussions,

however, are conspicuously absent from personal stories of suicide where the individual and

internal focus of most stories means that analysis rarely extends beyond a small circle of

interpersonal relationships to consider the social and historical circumstances of human lives.

Recent work in bioethics (Fitzpatrick, 2014), narrative therapy (Combs & Freedman, 2012),

as well as activist work in this area (Harris, 2014; Webb, 2010) provide useful alternatives to

the dominant individualized and pathologized constructions of suicide by paying attention to

issues of individual and cultural diversity and social justice, and by working to expose,

counter, and undermine the discourses and power relations inherent in research and

therapeutic practices.

Although Zahn’s work alludes to broader social justice issues (discrimination,

ineffective medical treatments, and a lack of choice in services), it does little to disrupt these

dominant practices, or to change the ways that suicide prevention and health services might

be conceived. This orienting away from social and political action toward medical

intervention and behavior change in personal stories of suicide is further evidence of the ways

in which mental health systems are able to harness the democratic and progressive values of

modern liberal societies to absorb oppositional accounts and enhance and solidify their own

interests (Costa et al., 2012). As Costa and others have argued, the appropriation of the

concept of personal recovery in the research and policy arenas and its resignification of

language such as empowerment, resilience, and struggle has worked to depoliticize resistance

accounts while at the same time using them to “further solidify hegemonic accounts of mental

illness” (2012, p. 87).

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Second, the entrepreneurial activity required to manage and improve the self places

considerable demands and responsibilities upon persons. Talk of the self as a ‘project’ and

associated notions of ‘responsibility,’ ‘authenticity,’ and ‘freedom’ have become part of our

contemporary vernacular, transforming our normative frameworks so that the gauge by which

persons now come to measure their lives is through a lens of personal initiative and the

capacity to ‘become oneself’ (Ehrenberg, 2010). Those who do not conform to these norms

and shared goals, or those who are incapable of developing the necessary skills required for

such a task, may be subject to further material effects, including disadvantage, discrimination,

and exclusion from telling their story. There are, after all, those whose experience of

suicidality is neither meaningful nor transformative and whose struggle with despair,

suffering, and failure presents no simple solutions (Fitzpatrick, 2014). The individualizing of

suicide in terms of causality, risk, treatment, and prevention also overlooks the extent to

which recovery is constrained (or enabled) by relations of gender, poverty, and class. We

must consider, therefore, whether the confessional narrative genre serves as a therapeutic

practice capable of truly enlightening and liberating persons or whether it merely produces a

new level of subjection in which psychological and therapeutic introspection is valorized at

the expense of other social interests and possibilities of expression (Bleakley, 2000).

Personal Stories of Suicide as Enabling or Restricting

Claims that the harnessing of personal stories of suicide by suicide prevention and health

promotion organizations has resulted in their institutionalization, commodification, and

homogenization raises difficult questions about the ‘truth’ and ‘authenticity’ of these

accounts. The personal confessional genre and its contribution to the formation and

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celebration of the self-determining, self-governing individual means that self-knowledge is

not, as is often assumed, simply a matter of delving into one’s own interior (Rimke, 2000).

The meaning of an event, action, or experience does not ‘speak for itself,’ but is forged

through processes of memory, reflection, interpretation, and imaginative telling. The

constructed nature of stories and their imposition of order on the raw flux of human

experience means that narrative provides not only a way of structuring experience, but of

transforming or redescribing those experiences (Prince, 2000). The range of interpretive and

discursive frameworks available for this task means that persons are able to represent their

experiences in a number of possible ways and to serve a variety of interests, ends, or

expectations.

However, because not all interpretations carry the same authority, the influence of

institutional interests are important qualifications when assessing the value of personal stories

of suicide and their capacity to enrich or constrain human lives. Not all first-person accounts

are naïve or uncritical, yet the preference for stories told by those who have had time to

recover and reflect on their experiences (American Association of Suicidology, 2014), and

the importance of connecting one’s lived experience to key suicide prevention messages

(Suicide Prevention Australia, 2014), means that personal stories of suicide often reflect

prevailing sociocultural and institutional norms and meanings.3 Thus, the overlapping and

mutually reinforcing discourses of suicide prevention and suicide attempt survivor narratives

play an important regulatory function through shaping the ways suicidal behavior is

understood, the ways it is subjectively experienced, and the ways it is best responded to.

There is, I accept, a risk in seeing the personal stories of suicide attempt survivors as

rigidly determined by institutional forces. Personal stories of suicide can act as sites of

22

conventional rhetoric, self-deception, and imitation, but they can also be sites of personal

liberation (Shapiro, 2011). Writing on the trustworthiness of patient narratives in medicine,

Johanna Shapiro implores readers to move beyond simplistic dichotomies of

authentic/inauthentic, transgressive/conformist, and true/invalid to be responsive to the

dynamic, multiple, and emergent meanings that illness and suffering might have for different

people. For many, the telling of their story may simply be guided by a desire to make sense of

their suffering and to find a way forward in their lives. The capacity of narrative to bestow

meaning, power, and social identity makes it an important resource for those living in the

face of trauma, illness, abuse, and personal tragedy, and the deployment of dominant cultural-

normative understandings need not represent a less authentic or simplistic response to these

human plights, nor make the self-change associated with them any less real.

One of the dangers of a critical reading of suicide attempt survivor stories is that, like

the practices of psychiatry and psychology before them, the social sciences risk

misappropriating the personal stories of suicide to serve particular sociopolitical interests. It

is important, therefore, that such critical approaches occur within a respectful and

compassionate context so as not to efface the voices of those who speak (Bracken & Thomas,

2005; Shapiro, 2011). However, we must also ask what the role of stories in suicide

prevention is and whether it is enough to simply ‘listen to these stories.’ Although there is

unquestionably a place for personal stories of suicide in suicidology, we should not forget

that the impetus behind active user movements such as the Gay Rights and Mad Pride

movements has been, and continues to be, the struggle against paternalism and those forms of

morality that stifle and obliterate difference (Bracken & Thomas, 2005).

23

If personal stories mark a starting point for active collaboration with suicide

prevention organizations, then we must acknowledge the institutional contexts and relations

of power in which this collaborative enterprise takes place. If the promise of rebuilding a

space for moral and political engagement in contemporary suicide prevention is to be realized

through the practice of personal storytelling, then the interpretive and discursive practices

through which suicidal subjectivities are constructed must become the subject of examination

and critique. This means engaging in the close reading of personal stories of suicide to see

how experiences of suicidal behavior are framed and what narrative resources are mobilized

to do this. In particular, we need to consider how relations of responsibility are configured

within these narratives (and in suicide prevention more broadly) and the ethical obligations

that are made upon persons. For it may be the case that the institutionalization of personal

stories of suicide results in the creating of a moral discourse that not only privileges certain

ways of talking about suicide, but that confers legitimacy on those select few who are able to

meet its strict demands. Rather than relinquishing power and challenging the homogeneity

and orthodoxy of public discourse on suicide by opening up suicidology to previously

excluded persons and groups, the institutionalization of personal stories of suicide may result

in the legitimation and maintaining of existing power relations, the instrumentalization of

personal stories of suicide, and the narrowing of the discussion on suicide and the ways it is

understood, experienced, and responded to.

Notes

1. See Atkinson (2009) and Brody (1997).

24

2. For stories published online see: American Association of Suicidology:

www.suicidology.org/suicide-survivors/suicide-attempt-survivors; Suicide Awareness Voices

of Education: www.save.org/index.cfm.

3. For an example of more critical works see Laura Delano

http://recoveringfrompsychiatry.com/2014/02/reflecting-life-death-suicide/; Leah Harris

www.madinamerica.com/author/lharris/; and David Webb’s Thinking about suicide (2010).

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